Aside from getting vaccines, students accessed the Evanston Township High School Health Clinic most for reproductive and mental health services during the 2016-17 school year.
Of the 3,173 clinical encounters recorded last year, the most common visit was for vaccine administration (688). Next 378 visits were for contraception, 333 were for routine physicals, 304 were mental health visits, 178 for health issues counseling and 50 for sports physicals. Other recorded encounters included repeat visits, follow-ups etc.
Sexually transmitted disease screening is “big” and the school has seen a “fair amount of chlamydia,” said Julie Holland, M.D., the clinic director, during a report on the school-based health clinic at the Jan. 16 District 202 School Board meeting.
According to the Cook County Department of Public Health, chlamydial infections are the most commonly reported communicable disease in suburban Cook County as well as the United States, yet underreporting is a problem as most patients with chlamydial infections are asymptomatic and do not seek testing. The CDC recommends annual chlamydia screening for all sexually active women 25 years of age and younger. Chlamydia can be cured with antibiotics.
Other common diagnosis at the health center include Pharyngitis /Sore Throat/Colds 56, Obesity 81, Sprains/Strains 41, Asthma 37, Acne 20, menstrual Disorders 41.
The ETHS Health Center has been in operation for 22 years. It is a component of North Shore Health Systems and is run in partnership with the Evanston Health and Human Services Department. Clinic staff – which include doctors, nurses and mental health professionals – are not employees of ETHS, and services are separate from those provided by the school nurse. All ETHS students are qualified to receive services at the health center regardless of whether or not they already have a doctor, and regardless of whether or not they are insured. Parents must sign on if students are under 18, unless accessing mental health or STI services which can be access by minors without parent consent under law.
The ETHS Health Center can serve as an added resource for health care, providing students with the opportunity to schedule appointments during the school day to manage chronic conditions or to see a doctor for a medical concern, said Dr. Holland. The Center can also provide students with access to services they might not otherwise receive with their pediatrician, including acupuncture, sports medicine and weight management.
Last year, of the 1,800 students registered at the center, 875 used services, 189 of whom were students from District 65 (funded though the State). More females than males accessed the clinic (57% vs 43%), and the recorded patient breakdown by race was 42% African American, 17% White, 15% Hispanic and 26% Unknown/not reported.
Board Member Gretchen Livingston, who sits on the advisory board for the clinic, mentioned how students were also accessing the clinic to explore health careers. Ida Joyce Sia, RN said that 10 students are on a new student advisory board which has been involved in clinic activities.
Board Member Pat Munsell asked what the biggest surprises and needs are for the clinic. “Mental health is always a priority and big need, “said Dr. Holland. “The need for a child psychologist is huge. We do a lot of triage.”
Dr. Holland also said she is continually surprised at the number of kids who can’t get insurance or who can’t access the benefits they have. She reported that 25% of the Center’s patients are uninsured, 44% are on Medicaid and 25% have privately-owned insured. “The state of Medicaid is tough to deal with,” she said referencing how Medicaid plans are now in managed care so referring to specialty care is often a problem. Transportation to sometimes distant in-network doctors make it even harder to get kids to services their insurance in theory covers.
The ETHS Health Center does not bill private insurers directly and most visits are free. The Center charges a small fee for physical exams, vaccines, and some lab tests. Students with Medicaid/All Kids do not have to pay. The State of Illinois provides about 25-30% of the clinic’s funding.
“School-based health clinics are really rare,” said Superintendent Eric Witherspoon who gave a “shout out” to North Shore University Health Systems for “making a decision to continue to place a high value” on student health care and to be onsite every day. “It’s a remarkable model, not a common model and I can’t imagine what our students would do without it.”